The knee. Probably the most common joint injured by athletes. Injuries can range from a simple bruise to complicated fractures and torn ligaments.
Many, if not all seasoned athletes would have endured some sort of injury before in their career. Surprisingly, these athletes can even self-diagnose themselves even before a single visit to the doctor. I myself am no exception to this. I endured a ruptured Anterior Cruciate Ligament during a national taekwondo tournament. Right after the injury, my friend and teammates were like “ this one surely ACL koyak bro”. And they were right. Could you really diagnose someone with torn ligaments just like that. After all, this particular ligament is seated deep within the knee join, so how could you say?
So the answer, yes you could suspect someone to have this injury based purely on history. With physical examination, one could be almost certain. Lets start with the history first. For this, allow me to take you down memory lane on my own torn ligament. Let me set the scene, as previously mentioned, it was a taekwondo tournament. There I was, in my first fight of the day, aiming to defend the national junior title I had won the year before. Attempting to land a kick on my opponent, I turned my body, kicking with my right leg. During this kicking motion, my left foot was firmly planted on the ground. In one swift motion, i could feel my entire body turn as I twisted my knee. In short, my left leg was not in sync with the rest of my body’s motion, thus resulting in a twisting injury to the knee. As this was happening, there was an audible “pop” sound heard. I fell to the ground in agony, unable to stand up let alone walk without assistance. As I rested, with ice on my knee, I had noticed that my knee had begun to swell up.
To summarise, during the initial trauma, the relevant history include the twisting mechanism injury, the pain, the “pop” sound, the inability to continue the sporting activity and lastly the almost immediate swelling. After a couple of weeks of rest and icing the knee, the pain and swelling will slowly subside. One will be able to slowly get back to walking in a few weeks and even back to some light sports. Now that the pain and swelling has resolved, patients (and myself at the time) will tend to get back into their sporting activities. This is when one might start to experience another symptom, instability.
Before we get into that, some light anatomy class The ACL is made out of two bundles, namely the Anteromedial (AM) and the posterolateral (PL) bundles. The AM is primarily responsible to control anterior translation of the knee, whereas the PM bundle controls the pivoting (twisting) motion. Symptoms of instability can vary amongst patients. They usually present with the feeling of the knee “giving way” when walking on slippery or uneven ground, when ascending or descending the stairs and even when crossing over something (like a drain). Apart from these symptoms, in athletes, they may complain of instability when making sudden pivoting movements. This includes motions like making sudden changes in direction, usually seen in court sports like futsal, basketball etc.
A thorough history taking will usually reveal these symptoms and be able to point the treating doctor in the right direction as physical examination starts. We’d look out for signs like swelling, bruising, tenderness and limitation in range of motion. More specifically, one will need to perform special test like the Lechmann Test, the Anterior Drawer Test to try and the Pivot Shift Test to determine if the ACL is damaged. Now, together with the history and examination, an ACL injury and be confidently diagnosed. However, it is important to keep in mind that other structures in the knee might have been injured too like that meniscus and the cartilages.
Finally, to confirm the diagnosis of an ACL injury as well as to look out for other possible injuries, your doctor might order a Magnetic Resonance Imaging (MRI) scan. This scan allows us to visualise strictures like the ligaments, meniscus and cartilages that we will not be able to see on an Xray. Treatment begins with physiotherapy to ensure adequate muscle strength is retained and maintain good range of motion. Surgery is indicated if there is persistent instability, whereby your doctor might advise on reconstruction of the ACL. However, it should be kept in mind that the success of the surgery is very much dependent on the post operative rehabilitation. So there you have it, go ahead and diagnose and treat that twisted knee of yours!
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